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1. Day or overnight transfusion in critically ill patients: does it matter?

Author

Aubron, C., Kandane-Rathnayake, R., Andrianopoulos, N., Westbrook, A., Engelbrecht, S., Ozolins, I., Bailey, M., Murray, L., Cooper, D., Wood, E., McQuilten, Z., Pettilä, V., Nichol, A., Syres, G., Phillips, L., Street, A., French, C., Orford, N., Santamaria, J., Bellomo, R., Vallance, S., McArthur, C., McGuiness, S., Newby, L., Simmonds, C., Parke, R., Buhr, H., Goldsmith, D., O'Sullivan, K., Mercer, I., Gazzard, R., Tauschke, C., Hill, D., Fletcher, J., Boschert, C., Koch, G., Ernest, D., Eliott, S., Howe, B., Hawker, F., Ellem, K., Duff, K., Henderson, S., Mehrtens, J., Milliss, D., Wong, H., Arora, S., O'Bree, B., Shepherd, K., Ihle, B., Ho, S., Graan, M., Bernsten, A., Ryan, E., Botha, J., Vuat, J., Kinmonth, A., Fraser, M., Richards, B., Tallott, M., Whitbread, R., Freebairn, R., Thomas, L., Parr, M., Micallef, S., Deshpande, K., Wood, J., Williams, Teresa, Tai, J., Boase, A., Galt, P., King, B., Price, R., Tomlinson, J., Cole, L., Seppelt, I., Weisbrodt, L., Gresham, R., Nikas, M., Laing, J., Bell, J., McHugh, G., Hancock, D., Kirkham, S., Shehabi, Y., Campbell, M., Aubron, C., Kandane-Rathnayake, R., Andrianopoulos, N., Westbrook, A., Engelbrecht, S., Ozolins, I., Bailey, M., Murray, L., Cooper, D., Wood, E., McQuilten, Z., Pettilä, V., Nichol, A., Syres, G., Phillips, L., Street, A., French, C., Orford, N., Santamaria, J., Bellomo, R., Vallance, S., McArthur, C., McGuiness, S., Newby, L., Simmonds, C., Parke, R., Buhr, H., Goldsmith, D., O'Sullivan, K., Mercer, I., Gazzard, R., Tauschke, C., Hill, D., Fletcher, J., Boschert, C., Koch, G., Ernest, D., Eliott, S., Howe, B., Hawker, F., Ellem, K., Duff, K., Henderson, S., Mehrtens, J., Milliss, D., Wong, H., Arora, S., O'Bree, B., Shepherd, K., Ihle, B., Ho, S., Graan, M., Bernsten, A., Ryan, E., Botha, J., Vuat, J., Kinmonth, A., Fraser, M., Richards, B., Tallott, M., Whitbread, R., Freebairn, R., Thomas, L., Parr, M., Micallef, S., Deshpande, K., Wood, J., Williams, Teresa, Tai, J., Boase, A., Galt, P., King, B., Price, R., Tomlinson, J., Cole, L., Seppelt, I., Weisbrodt, L., Gresham, R., Nikas, M., Laing, J., Bell, J., McHugh, G., Hancock, D., Kirkham, S., Shehabi, Y., and Campbell, M.

Abstract

Background and objectives: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. Materials and methods: This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed. Results: The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12% of patients transfused in daytime only versus 30% of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95% confidence interval, 2·00–5·01). Conclusion: Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.

Published
2018

2. Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

Author

Bellomo, R, Cass, A, Norton, R, Gallagher, M, Lo, S, Su, S, Cole, L, Finfer, S, McArthur, C, McGuinness, S, Myburgh, J, Scheinkestel, C, Lee, J, Ali, D, Goldsmith, D, Banerjee, A, Bhonagiri, D, Blythe, D, Botha, J, Cade, J, Dobb, G, Eddington, J, Flabouris, A, French, C, Garrett, P, Henderson, S, Ihle, B, Joyce, C, Kalkoff, M, Lipman, J, Milliss, D, Mitchell, I, Morgan, J, Nair, P, Orford, N, Raza, A, Shehabi, Y, Tobin, A, Totaro, R, Turner, A, Wright, C, Little, L, Morrison, A, Regaglia, G, Shukla, R, Baigent, C, Emberson, J, Wheeler, D, Young, D, Billot, L, Bompoint, S, Heritier, S, Lo, SN, Pillai, A, Pandey, S, Ryan, S, Schmidt, M, Starzec, G, Vijayan, B, Ashley, R, Gissane, J, Malchukova, K, Ranse, J, Nand, K, Sara, T, Cheung, W, Fugaccia, E, Lawrence, P, Millis, D, Tan, J, Thankrishnan, G, Wong, H, Harrigan, P, Crowfoot, E, Hardie, M, Micallef, S, Brieva, J, Lintott, M, Seppelt, I, Gresham, R, Nikas, M, Weisbrodt, L, Bass, F, Boyle, M, Campbell, M, Hammond, N, Ankers, S, O'Connor, A, Potter, J, Rajbhandari, D, Dhiacou, V, Jovanovska, A, Munster, F, Breeding, J, Burns, C, Morrison, M, Pfeffercorn, C, Ritchie, A, Buhr, H, Eccleston, M, Parke, R, Bell, J, Newby, L, Mehrtens, J, West, C, Rudder, L, Sutton, J, Groves, N, McDonald, S, Jaspers, J, Harwood, M, Helyar, J, Mackie, B, Boots, R, Bertenshaw, C, Deans, R, Fourie, C, Lassig-Smith, M, Stuart, J, Edwards, J, O'Connor, S, Lewis, K, Rivett, J, Field, T, McAllister, R, Marsden, K, Mathlin, C, Mercer, I, O'Sullivan, K, Edington, J, Boschert, C, Smith, J, Graan, M, Ho, S, Fowler, N, McInness, J, Pratt, N, Elderkin, T, Fraser, M, Kinmonth, A, Barrett, J, Wilson, S, Galt, P, Burton, S, Culhane, C, Ioannidis, R, Roberston, M, Barge, D, Caf, T, Howe, B, Low, P, Holmes, J, Smith, R, Davies, A, Murray, L, Nevill, R, Vallance, S, Varley, S, White, V, Raunow, H, Palermo, A, Boardman, M, Chamberlain, J, Gould, A, McEntaggart, G, Perryman, S, Thomas, L, and In, RENALRTS

Subjects
Male, medicine.medical_specialty, Randomization, Critical Illness, medicine.medical_treatment, Hemodiafiltration, Kaplan-Meier Estimate, law.invention, Randomized controlled trial, law, Internal medicine, medicine, Humans, Prospective Studies, Renal replacement therapy, Prospective cohort study, Aged, business.industry, Acute kidney injury, General Medicine, Odds ratio, Acute Kidney Injury, Middle Aged, medicine.disease, Confidence interval, Surgery, Treatment Outcome, Female, business, Hypophosphatemia
Abstract

Background The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, delivered at two different levels of intensity, on 90-day mortality among critically ill patients with acute kidney injury. Methods We randomly assigned critically ill adults with acute kidney injury to continuous renal-replacement therapy in the form of postdilution continuous venovenous hemodiafiltration with an effluent flow of either 40 ml per kilogram of body weight per hour (higher intensity) or 25 ml per kilogram per hour (lower intensity). The primary outcome measure was death within 90 days after randomization. Results Of the 1508 enrolled patients, 747 were randomly assigned to higher-intensity therapy, and 761 to lower-intensity therapy with continuous venovenous hemodiafiltration. Data on primary outcomes were available for 1464 patients (97.1%): 721 in the higher-intensity group and 743 in the lower-intensity group. The two study groups had similar baseline characteristics and received the study treatment for an average of 6.3 and 5.9 days, respectively (P = 0.35). At 90 days after randomization, 322 deaths had occurred in the higher-intensity group and 332 deaths in the lower-intensity group, for a mortality of 44.7% in each group (odds ratio, 1.00; 95% confidence interval [CI], 0.81 to 1.23; P = 0.99). At 90 days, 6.8% of survivors in the higher-intensity group (27 of 399), as compared with 4.4% of survivors in the lower-intensity group (18 of 411), were still receiving renal-replacement therapy (odds ratio, 1.59; 95% CI, 0.86 to 2.92; P = 0.14). Hypophosphatemia was more common in the higher-intensity group than in the lower-intensity group (65% vs. 54%, P Conclusions In critically ill patients with acute kidney injury, treatment with higher-intensity continuous renal-replacement therapy did not reduce mortality at 90 days. (ClinicalTrials.gov number, NCT00221013.)

Published
2016

3. Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial.

Author

Nair P., Kalkoff M., West C., Morgan J., Rudder L., Sutton J., Garrett P., Groves N., McDonald S., Jennifer Palmer a., Joyce C., Harwood M., Helyar J., Mackie B., Lipman J., Boots R., Bertenshaw C., Deans R., Fourie C., Lassig-Smith M., Flabouris A., Edwards J., O'Connor S., Rivett J., Turner A., Field T., Marsden K., Mathlin C., Goldsmith D., Mercer I., O'Sullivan K., Edington J., Boschert C., Smith J., Ihle B., Graan M., Ho S., Botha J., Fowler N., McInness J., Pratt N., Orford N., Elderkin T., Fraser M., Kinmonth A., Wright C., Burton S., Culhane C., Galt P., Rutzou R., Roberston M., Barge D., Caf T., Howe B., Low P., Tobin A., Holmes J., Smith R., Murray L., Nevill R., Vallance S., Varley S., White V., French C., Little L., Raunow H., Blythe D., Palermo A., Dobb G., Boardman M., Chamberlain J., Gould A., McEntaggart G., Perryman S., Thomas L., Bellomo R., Cass A., Cole L., Finfer S., Gallagher M., Lee J., Lo S., McArthur C., McGuinness S., Myburgh J., Norton R., Scheinkestel C., Mitchell I., Ashley R., Gissane J., Malchukova K., Ranse J., Raza A., Nand K., Sara T., Millis D., Tan J., Wong H., Harrigan P., Crowfoot E., Hardie M., Bhonagiri D., Micallef S., Brieva J., Lintott M., Gresham R., Nikas M., Weisbrodt L., Shehabi Y., Bass F., Campbell M., Stockdale V., Ankers S., O'Connor A., Potter J., Totaro R., Rajbhandari D., Dhiacou V., Jovanovska A., Munster F., Davies A., Breeding J., Burns C., Banerjee A., Morrison M., Pfeffercorn C., Ritchie A., Buhr H., Eccleston M., Parke R., Bell J., Newby L., Henderson S., Mehrtens J., Nair P., Kalkoff M., West C., Morgan J., Rudder L., Sutton J., Garrett P., Groves N., McDonald S., Jennifer Palmer a., Joyce C., Harwood M., Helyar J., Mackie B., Lipman J., Boots R., Bertenshaw C., Deans R., Fourie C., Lassig-Smith M., Flabouris A., Edwards J., O'Connor S., Rivett J., Turner A., Field T., Marsden K., Mathlin C., Goldsmith D., Mercer I., O'Sullivan K., Edington J., Boschert C., Smith J., Ihle B., Graan M., Ho S., Botha J., Fowler N., McInness J., Pratt N., Orford N., Elderkin T., Fraser M., Kinmonth A., Wright C., Burton S., Culhane C., Galt P., Rutzou R., Roberston M., Barge D., Caf T., Howe B., Low P., Tobin A., Holmes J., Smith R., Murray L., Nevill R., Vallance S., Varley S., White V., French C., Little L., Raunow H., Blythe D., Palermo A., Dobb G., Boardman M., Chamberlain J., Gould A., McEntaggart G., Perryman S., Thomas L., Bellomo R., Cass A., Cole L., Finfer S., Gallagher M., Lee J., Lo S., McArthur C., McGuinness S., Myburgh J., Norton R., Scheinkestel C., Mitchell I., Ashley R., Gissane J., Malchukova K., Ranse J., Raza A., Nand K., Sara T., Millis D., Tan J., Wong H., Harrigan P., Crowfoot E., Hardie M., Bhonagiri D., Micallef S., Brieva J., Lintott M., Gresham R., Nikas M., Weisbrodt L., Shehabi Y., Bass F., Campbell M., Stockdale V., Ankers S., O'Connor A., Potter J., Totaro R., Rajbhandari D., Dhiacou V., Jovanovska A., Munster F., Davies A., Breeding J., Burns C., Banerjee A., Morrison M., Pfeffercorn C., Ritchie A., Buhr H., Eccleston M., Parke R., Bell J., Newby L., Henderson S., and Mehrtens J.

Abstract

Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes. Method(s): We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models. Result(s): Overall, mean DCI during treatment in ICU was low at only 10.9 +/- 9 Kcal/kg/day for non-survivors and 11 +/- 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling. Conclusion(s): In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes. © 2014 Bellomo et al.; licensee BioMed Central Ltd.

Published
2014

4. Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial

Author

Bellomo, R, Cass, A, Cole, L, Finfer, S, Gallagher, M, Lee, J, Lo, S, McArthur, C, McGuinness, S, Myburgh, J, Norton, R, Scheinkestel, C, Mitchell, I, Ashley, R, Gissane, J, Malchukova, K, Ranse, J, Raza, A, Nand, K, Sara, T, Millis, D, Tan, J, Wong, H, Harrigan, P, Crowfoot, E, Hardie, M, Bhonagiri, D, Micallef, S, Brieva, J, Lintott, M, Gresham, R, Nikas, M, Weisbrodt, L, Shehabi, Y, Bass, F, Campbell, M, Stockdale, V, Ankers, S, O'Connor, A, Potter, J, Totaro, R, Rajbhandari, D, Dhiacou, V, Jovanovska, A, Munster, F, Nair, P, Breeding, J, Burns, C, Banerjee, A, Morrison, M, Pfeffercorn, C, Ritchie, A, Buhr, H, Eccleston, M, Parke, R, Bell, J, Newby, L, Henderson, S, Mehrtens, J, Kalkoff, M, West, C, Morgan, J, Rudder, L, Sutton, J, Garrett, P, Groves, N, McDonald, S, Jennifer Palmer, A, Joyce, C, Harwood, M, Helyar, J, Mackie, B, Lipman, J, Boots, R, Bertenshaw, C, Deans, R, Fourie, C, Lassig-Smith, M, Flabouris, A, Edwards, J, O'Connor, S, Rivett, J, Turner, A, Field, T, Marsden, K, Mathlin, C, Goldsmith, D, Mercer, I, O'Sullivan, K, Edington, J, Boschert, C, Smith, J, Ihle, B, Graan, M, Ho, S, Botha, J, Fowler, N, McInness, J, Pratt, N, Orford, N, Bellomo, R, Cass, A, Cole, L, Finfer, S, Gallagher, M, Lee, J, Lo, S, McArthur, C, McGuinness, S, Myburgh, J, Norton, R, Scheinkestel, C, Mitchell, I, Ashley, R, Gissane, J, Malchukova, K, Ranse, J, Raza, A, Nand, K, Sara, T, Millis, D, Tan, J, Wong, H, Harrigan, P, Crowfoot, E, Hardie, M, Bhonagiri, D, Micallef, S, Brieva, J, Lintott, M, Gresham, R, Nikas, M, Weisbrodt, L, Shehabi, Y, Bass, F, Campbell, M, Stockdale, V, Ankers, S, O'Connor, A, Potter, J, Totaro, R, Rajbhandari, D, Dhiacou, V, Jovanovska, A, Munster, F, Nair, P, Breeding, J, Burns, C, Banerjee, A, Morrison, M, Pfeffercorn, C, Ritchie, A, Buhr, H, Eccleston, M, Parke, R, Bell, J, Newby, L, Henderson, S, Mehrtens, J, Kalkoff, M, West, C, Morgan, J, Rudder, L, Sutton, J, Garrett, P, Groves, N, McDonald, S, Jennifer Palmer, A, Joyce, C, Harwood, M, Helyar, J, Mackie, B, Lipman, J, Boots, R, Bertenshaw, C, Deans, R, Fourie, C, Lassig-Smith, M, Flabouris, A, Edwards, J, O'Connor, S, Rivett, J, Turner, A, Field, T, Marsden, K, Mathlin, C, Goldsmith, D, Mercer, I, O'Sullivan, K, Edington, J, Boschert, C, Smith, J, Ihle, B, Graan, M, Ho, S, Botha, J, Fowler, N, McInness, J, Pratt, N, and Orford, N

Abstract

Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.Methods: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.Results: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.Conclusions: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes. © 2014 Bellomo et al.; licensee BioMed Central Ltd.

Published
2014

6. Sociability and the feeling of loneliness of the elderly in the municipalities of Attica.

Author

Nikas M, Sotiropoulou K, Makrinika E, Paralikas T, Papathanasiou I, Lahana E, Prapa E, Koulouri A, and Roupa Z

Abstract

It is clear that health is influenced by various factors related to the existing cultural, economic, and social conditions such as marital status, educational level, living conditions, quality of life, interpersonal relations, sociability, etc. In particular, all these parameters are more important in vulnerable age groups such as senior citizens. The purpose of this research is to study how older people experience their everyday lives, compared with those in their close and wider environment, in order to understand the wide range of their needs, including the need for support and social contact. Material and method: For this research the sample consisted of 300 individuals (147 men and 153 women) aged 59-98 years (mean age 73.57 years) from the Open Centers for the Elderly of Attica. The collection of data has taken place by using questionnaire, after a personal interview of the researcher. The analysis of the results was done by using the statistical package SPSS 15. Results: The sample was consisted in 51% of women and 49% of men. 57.3% of the respondents stated that they were married. A significant proportion of the sample of this study, 47.7%, indicates that it feels the sense of solitude. A comparison between the feeling of loneliness and sex, shows that women seem to experience loneliness in a more intense way than men. About the social contacts of the respondents, it is shown that women, 32.0%, seem to prefer social relations with their relatives, while 52.4% of men prefer to have a wider social circle. People who declare they feel lonely, are generally older than those who do not feel lonely. The marital status appears to play an important role in loneliness. The greatest percentages of loneliness appear to elderly single people, 71.4%, in those who are separated, 100%, and those who have lost their spouse, 81.7%. About the social relations of the elderly, 44.3% say they have social contacts with relatives, friends and neighbors, while 27% restrain their contacts only to close relative persons.Conclusions: The institution of family is of paramount importance for the elderly. The fact that older people are experiencing intense loneliness, may mean that usually there is not a sufficient support system, including their family and the wider environment. This outpoints the need for measures by the state and all people, in order to cope with an important problem of this age group. [ABSTRACT FROM AUTHOR]

Published
2009

7. Thyroid cancer in Greece. A tertiary center experience.

Author

Gkountouvas A, Nikas M, Chatjimarkou F, Thomas D, Georgiadis P, and Kaldrimidis P

Subjects
Adenocarcinoma, Follicular epidemiology, Carcinoma epidemiology, Carcinoma, Medullary epidemiology, Carcinoma, Papillary, Carcinoma, Squamous Cell epidemiology, Follow-Up Studies, Greece, Hodgkin Disease epidemiology, Humans, Lymphoma, Non-Hodgkin epidemiology, Medical Records, Neoplasm Staging, Prognosis, Retrospective Studies, Thyroid Cancer, Papillary, Thyroid Neoplasms epidemiology, Adenocarcinoma, Follicular pathology, Carcinoma pathology, Carcinoma, Medullary pathology, Carcinoma, Squamous Cell pathology, Hodgkin Disease pathology, Lymphoma, Non-Hodgkin pathology, Thyroid Neoplasms pathology
Abstract

Purpose: to present the frequency and distribution of histological subtypes of primary thyroid carcinoma cases diagnosed at our Department., Methods: we retrospectively analyzed the records of all patients with primary thyroid carcinoma admitted to our Department from January 01, 2002 until December 31, 2008., Results: of 1,607 patients with primary thyroid carcinoma 1510 (94%) suffered from differentiated thyroid carcinoma (DTC), 71 (4%) from medullary thyroid carcinoma (MTC), 10 (< 1%) from anaplastic thyroid carcinoma (ATC), 9 (<1%) from primary thyroid non Hodgkin's lymphoma, 1 (< 1%) from primary thyroid Hodgkin's lymphoma, 1 (< 1%) from squamous cell carcinoma of the thyroid, and 6 patients (< 1%) suffered from carcinoma of ectopic thyroid tissue (1 malignant struma ovarii, 2 carcinoma in thyroglossal duct remnants, and 3 patients presented with thyroid tissue carcinoma in cervical lymph nodes)., Conclusion: differentiated thyroid carcinoma is by far the most common primary malignancy of the thyroid gland. Papillary thyroid carcinomas constitute the vast majority of these neoplasms. Larger studies are necessary to better understand and evaluate the clinical characteristics, behavior and prevalence of thyroid cancer in our country.

Published
2010

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